HomeMy WebLinkAbout02-15-13PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND ___ COUNTY, PENNSYLVANIA
Petitioner(s) named below, who is/are I8 years of age or older, apply(ies) for Letters as specified below, and in
support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form:
Decedent's Information
Name: Robert B. Peck _ _
a/k/a:
a/k/a:
a/k/a:
Date of Death:
2/2/2013
File No: `___'a --- ,-.
(Assigned by Register)
Social Security No: _
Age at death: 87 ___ ._____ _
Decedent was domiciled at death in Cumberland County, PA __ (State) with his/her last
principal residence at 910 Macoun Drive 17055 Upper_Allen Township __-Cumberland _
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at 910 Macoun Drive 17055 Upper Allen Township Cumberland PA
Street address, Post Office and Zip Code City, Township or Borough County State
Estimate of value of decedent's property at death
If domiciled in Pennsylvania ................................All personal property $ --
Ifnot domiciled in Pennsylvania .............................Personal property in Pennsylvania $ --
Ifnot domiciled in Pennsylvania .............................Personal property in County $ _ _____--
Value of real estate in Pennsylvania .............................................................. $ __-_.___ 300, 000.00
TOTAL ESTIMATED VALUE.... $ 300.000.00
Real estate in Pennsylvania situated at: 91 O Macoun DfIVe 17055 __.__U~per Allen Townshi~__ Cumberland
(Attach additinnal.chee~.~•, iJ~nece.csa~~~.) Street address, Post Office and Zip Code City, Township or Borough County
® A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated 1~_/~~ZQ~_2- and Codicil(s)
thereto dated _.-.__._.__ _ - ---.-- ------ -
State relevant circumstances (e.g. renunciation, death of executor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. ~ 3323(8), and did not have a child born or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
® NO EXCEPTIONS ^ EXCEPTIONS
^ B. Petition for Grant of Letters of Administration (If applicable) _ _ _______ _-
c.t.a., d. b. n., d. b. n. c. t. a., pendente life, di+rante absentia, durante minoritate
If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of_heirs.
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had keen established as defined
in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
^ NO EXCEPTIONS ^ EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attach
additional sheets, if necessary):
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Oath of Personal Representative ot~~~a~ us~, oT~iy
COMMON WEALTH OF :PENNSYLVANIA } R E ~ Q ~{ ~ ~; ~ ~" ~~ i ~~ ~ ~ F
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., etitioner(s) Printed Name =_ ~.
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~ 337 East Meadow Drive
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910 Macoun Drive _
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-filae.~'etitioner(s)~~ove-nan3~d swear(s) or affirm(s) the statements in the foregoing Petition are true and correct to the best of the knowledge and belief
~~ off` Petitioner(s) and that; a~ 1~'Frsonal Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate according to law.
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Svr!orn to or t3-med ~- .subscribed before Uate . ~ ~~
2013
me.tlZ'r ~ ~ day,c3f _ - ~ -- _._ Date
B'Y,~~ ~ ~-~ '' - --- Uate _
~Fer.tj2e , , egister ~,- ,~ ~., ~~~~ r CEO ~~ _ Date - _.
BOND Required: ^ YES ® NO
FEES:
Letters ....................... $ __ 310.00
( -~, )Short Certificates(s) ..... .
( )Renunciation(s) ..........
( )Codicil(s) ..............
( )Affidavit(s) .............
Bond ......................... -
Commission .................... _
Other _ -_ ......... _
Will _ ......... _ 15.00
Inheritance Tax ___ ......... _ 15.00
Automation Fee ................. _ 5.00
1CS Fee ....................... _ 23.50
TOTAL ......................$ __ 368.50
To the Register of Wills:
Please enter my appearance by my signature belc-w:
Attorney S~ ature:
Printed Name: Richard L. GingriC ___ _
Supreme Court
ID Number: 2_3305_ _______ _ _.
Firm Name: .Houck & GingrlCh _
Address: PO BOX 430 _
Lewistown PA 17044
Phone: ~717~248-6751 _
Fax: ~717~248-6135 __ __ _
Email: hglaw~awerizon.net ________ _
DECREE OF THE REGISTER
Estate of Robert B. Peck _ File No: . ~~%_ 1 __ ~_, : ~ 1 _
a/k/a: _ _- _
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Register of Wills _ . ~~
hbrm KW-02 rev. l0'll 2011 `.
AND NOW, -~- ~ ~~ -~~~- ' "~ I~_~ 2013 ____ , in consideration of the foregoing Petition,
satisfactory proof having been prese teed before me, IT IS DECREED that Letters Testaments _____~ _ ~_
_ ~r hereby granted to Larry R. Peck and Pamela J. Peck
_ in the above estate and ~;if app cable) that
the instrument(s) dated 11 /2/2012 __ _____ _- _ _ _
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)} of Decedetrt.
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Type/Print In COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH VITAL RECORDS
Permanent CERTIFICATE OF DEATH
Black Ink State File Number:
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1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Dale of Death (MO/Day/Yr) (Spell Mo)
Robert B. ]?eclc ale 196-14-8313 FF~bruary 2 2013
Sa. Age-Last Birthday (Vrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (MO/D ay/Near) (Spell Month) 7a. Birthplace (City and S tate or Foreign Country)
Months Days Hours Minutes Lewistown PA
8 7 September 1 7 1 9 2 5 7b. Birthplace (county) M i f f l i n
8a. Residence (State or Foreign Country) 86. Residence (Street and Number -Include Apt No.) 8c. Dld Decedent Llve in a Township?
P A 9 1 0 M a e o un Drive Ves, decedent lived in U p~~ r Allen _ _ cwp.
8d. Residence (County)
Cumber 1 a nd Se. Residence (Zip Code) 1 7 O 5 5 Q No, decedent Ilved within limits of __ city/born.
9. Ever in US Armed Forces? 10. Marital Status at Tlme of Death Q Married :~' Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage)
Yes Q No Q Unknown Q Divorced Q Never Married Q Unknown
12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last)
Helen Pr
14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zlp Code)
Larr Peck son 337 E. Meadow Dr Mechanicsburg PA
- _ - 1_Sa. P ace o Deat C ec_ o_n Lr one _
- - _ - - -_ - - _ _ - - - -
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- - - - _ - - - _ _ _ - - - - _ _ _
If Death Occurred in a Hospital: ^ Inpatient I if Death Occurred Somewhere Other Than a Hospital ~ Hospice Facility ~ecedentt's Home
° Q Emergency Room/Outpatient Q Dead on Arrival 1 Q Nursing Home/Long-Term Care Facility Q Other (Specify)
o`~ 15 b. Facility Name (if not institution, glue street and number) i5c. City or Town, State, and Zip Code 15d. County of Death
910 Macoun Drive Mechanicsburg PA 17055 Cumberland
16a. Method of Disposition ~~Burlal Q Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place)
v Q Removal from State Q Donation
Q O[her(Specify)
Feb 9 2013
Juniata Memorial_ Park
16d. Location of Disposition (City or Town, State, and ZI p) 17a. SI ature of Funeral Service Licensee or Person in Charge of Interment 17b. License Number
Lewistown, PA 17044 -~---_ FD 138718--L
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~, 17c. Name and Complete Address o1` Funeral Facility
Hoenstine Funeral Home 75 Lo an St Lewistown, PA 17044
m 18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to indicate what
~ highest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be.
Q 8th grade or less Is Spanish/Hlspa nic/Latino. Check the "No" .B White Q Korean
Q No diploma, 9th - 12th grade box if decedent is not Spanls h/Hispanic/Latino. Q Black or African American Q Vietna me!:e
~• High school graduate or GED coo mpleted $' No, not Spanish/Hlspa nic/Latino Q American indlan or Alaska Native Q Other Asian
Q Some college credit, but no degree Q Ves, Mexlca n, Mexican American, Chicano Q Asian Indian Q Native Hawaiian
Q Associate degree (e.g. AA, AS) Q Ves, Puerto Rican Q Chinese Q Guamanian or Cha motto
Q Bachelor's degree (e.g. BA, AB, BS) Q Yes, Cuban Q FIIlpino Q Samoan
Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino C) Japanese Q Other Pacific Islander
Q Doctorate (e.g. PhD, EdD) or Professional degree (Specify) _ Cl Other (Specify) ___ _
e. MD DDS DVM LLB, JD
21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation - IndicaCe type of work
)~ White Q Japanese Q Samoan done during most of working life. DO NO"T USE RETIRED.
Q Black or African American Q Korean Q Other Pacific Islander
Q American Indian or Alaska Native Q Vietna mdse Q Don't Know/Not Sure M a 1 1 ~~ a r t i e r
Q Asian Indian Q Other Asian Q Refused 22b. Kind of BusinPSS/Industry
Q Chinese Q Native Hawaiian Q Other (Specify)
P o s t a l S e r v i c e
Q FIIlpino Q Guamanian or Chamorro
ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (Mo Day/V r) 23 b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number
CERTIF E9 DEATH PRONOUNCES OR ~ ~b ~ ~
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23d. Date Signed (Mo/Day/Vr) 24. Time of Death ...
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25. Was Medical Examiner or Coroner Contacted? Q Ves
f~' No
CAUSE OF DEATH ~ Approximate
26. Part 1. Enter the chain of events--diseases, Injuries, or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest, 1 Interval:
respiratory arrest, or ventricular flbrill
REVIATE. F..nter only one cause on a Ilne. P,dd addltlo nal Ilnes if necessary. 1 Onset to Death
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howing the etlo logy. DO NOT AB
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IMMEDIATE CAUSE -------------__-> a. 1"~E'it ~-c-S_ 1 c-all L• ~,O ~C'l ~.~~Z4.~~ l~-_~~Q.~~ 1
(Final disease or condition Due to (or as a consequence of): 1
resulting in death) 1
1
b.
-_ _-- ___- I --
Sequentially list conditions, Due to (or as a consequence of): 1
If any, leading to the cause I
listed on Ilne a. Enter the c. _ _______ 1
u
UNDERLYING CAUSE Due to (or as a consequence of): 1
W (disease or Injury'that 1
- Initiated the events resulting d. ___ ____ ____ __ I
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V_ in death) LAST. Due to (or as a consequence of): 1
1
26. Part 11. Enter other signlfica n[ conditions contributing to death but not resulting in the underlying cause given In Part 1. 27. Was an autopsy pe~rformed7
° 0 Yes No
~ 28. Were autopsy find ngs available
m '7 to complete the cause of death?
Q Ves ~TVO
_ 29. If Female: ' 30. Did Tobacco Use Contribute to Death? 31. Manner of Death
E Q Not pregnant within past year Q Yes Q Pro babl
y
;®' Natural Q Homicide
v Q Pregnant at time of death (~ No Q Unknown Q Accident Q Pending Investigation
Q Not pregnant, but pregnant: within 42 days of death Q Suicide Q Could not be determined
.° Q Not pregnant, but pregnant: 43 days to 1 year before death 32. Date of Injury (Mo/Day/Yr) (Spell Month)
Q Unknown if pregnant within the past year 33. Time of Injury
34. Plac¢ of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, Cfty, County, State, ;!Ip Code)
36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred:
Q Yes Q Driver/Operator Q Pedestrian t
Q No Q Passenger Q other (Specify) _
39a.~ertifier -physician, certified nurse practitioner, medical examiner/coroner (Check only one):
~EJ( Certifying only - To thr_ best of my knowledge, death occurred due to the ca us¢(s) and manner stated.
Q Pronouncing Sa Certifying - To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated.
Q Medical Examiner/Co
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oner - O
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/or Investigation, In my opinion, death occurred at the time, date, anti place, and due to the cause(s) and manne
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Signature of certifier:~Q-~u~~-X_-~` 'wwb.vliyi__J Title of certifier: ~`-'~.~ License Number: ~.D ~~-4_33 L.-
396. Name, Address and Zip Code of Person Completing Cause of Death (Item 26) l~u~L ~ ~~ f~SS K 39c. Date Signed (Mo/Day/Yr)
moo ~dvt4, c.c n coG`~ ,Av-e_~iL..t, Le,b0..n.mn- 1=~A 1 ~L-k'2- v2 05 2013
40. Registrar's District Number 41. Registrar's Signature 42. Re
gistr
ar File Date (MO
/ ay/V r)
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43. Amendments
Disposition Permit fJn. ~ O_4. V.1~.~.~->_.. _-___.___-__-_._ Rr~.~,t (~7/2Crt2
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WILL
I, :Robert B. Peck, currently of the Commonwealth of Pennsylvania, being
of sound mind, memory and understanding do make and publish this my Last
Will an<d Testament hereby revoking and making void all former `JVills by me at
any tim heretofore made.
ITEM ONE: I direct all my debts which may be legally collectible, and
funeral expenses, be paid by my Executors hereinafter named.
ITEM TWO: All federal, state and other death taxes payab:~e because of
my death, with respect to the property forming my gross estate for tax purposes,
whether or not passing under this Will, including any interest or penalty imposed
in connection with such tax, shall be considered a part of the expense of the
administration of my estate and shall be paid from my residuary estate under
ITEM FOUR without apportionment or right of reimbursements All suc~'taxes~
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on present or future interests shall be paid at such time or time ~~ m egos
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may thi°~k proper regardless of whether such taxes are then due: ,fie ~~ ..
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ITEM THREE: I give and bequeath my residence and h;avs~hc~ld ~.3 -Y~ 4°~
furnishings located at 910 Macoun Drive, Mechanicsbur :Pe ~~s ~lvani+.+~~ ~~,~ ~~
g~ ~ y ~ to ~i~
daughter, Pamela J. Peck.
ITEM FOUR: All the rest, residue and remainder of my estate of which I
LAW OFFICES
HOUCK&GINGRICH shall die seized and possessed, or to which I shall be entitled at m;y decease of
23 N. WAYNE STREET
P.O. BOX 430
LEWISTOWN, PA. 17044 every nature and wherever situate I give, devise and bequeath equally to my
children, Larry R. Peck and Pamela J. Peck. In the event a said child of mine is
1
not living on the thirty-first day following my death, said deceased child's share
shall go to said deceased child's issue per stirpes living on the thirty-first day
following my death and in default of any such issue to the other shares herein
specified..
ITEM FIVE: I nominate, constitute and appoint my children, Larry R.
Peck and Pamela J. Peck, or the survivor of either, as Executors c-f this my Last
Will ann Testament.
ITEM SIX: I direct that my Executors, or their successor, shall not be
required to give bond for the faithful performance of their duties in any
jurisdiction.
ITEM SEVEN: No interest (including, but not limited to all shares of
principal and income) of any beneficiary under this Will o:r any Cl~dicil hereto or
any trust herein created shall be subject to anticipation or voluntary or
involuntary alienation.
In Witness Whereof, I, Robert B. Peck, the Testator, have to this my Last
Will and 'Testament, set my hand and seal (to this instrument only] this
f~
E ~~` ~ day, or /f ~~'`- ~-`°~ ;~!~`~~ ~`~ ,r ~'~'
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~~ - : ~~~ ~ -~ ~ ~. SEAL
LAW OFFICES
HOUCK 8 GINGRICH
23 N. WAYNE STREET
P.O. BOX 430
LEWISTOWN, PA. 17044
Signed, sealed, published and declared by the above-named Robert B.
Peck, Testator, as and for his Last Will and Testament, in t:he presence of us who
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have hereunto subscribed our names at his request thereto in the ;presence of the
said Testator and of each other
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A,C~N~~V]~~I1i-~~~?~T
Commonwealth of Pennsylvania
County of Mifflin
I, Robert B. Peck, the Testator whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will and
Testament; and that I signed it willingly and as my free and voluntary act for the
purposes therein expressed.
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Robert B. Peck
LAW OFFICES
HOUCK 8 GINGRICH
23 N. WAYNE STREET
P.O. BOX 430
LEWISTOWN, PA. 17044
Sworn to or affirmed and acknowledged
before me by Robert B. Peck, the
Testator, this ~~',~ of
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otary Public
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AFFIDAVIT
Commonwealth oi' Pennsylvania
County of Mifflin
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the witnesses whose names are signed to the attached or foregoing instrument,
LAW OFFICES
HOUCK 8 GINGRICH
23 N. WAYNE STREET
P.O. BOX 430
LEWISTOWN, PA. 17044
being dcly qualified according to law, do depose and say that we were present
and saw the Testator sign and execute the instrument as his Last Will and
Testament; that the Testator signed willingly and executed it as his free and
voluntary act for the purposes therein expressed; that each subscribing witness in
the hearing and sight of the Testator signed the will as a witness; and that to the
best of our knowledge the Testator was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
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Sworn tc~ or affirmed and subscribed to
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before me by ~ ' ~" ~ ~' / ~ . r ~ ~;~_.< ~ and
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witnesses, this
,~,~~, ~~ day of ,~~~"`7/~,~~~L~-~-~ ~% 2012.
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'`~"o ar Public
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LOiS K 8008, NOTARY PtfBLIC
1~1IItIST'01~1 BORO. t~IfFUN t~UNTY
AMY C0l,A~ISSttNI EXPIRES 0CL ~~ 2015
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